不同取精方式行ICSI对临床妊娠及围产结局的影响  

Effects of different sperm extraction methods on clinical pregnancy and perinatal outcome

作　　者：刘洋 杨璐 王云霞 熊奕雯 任炳楠 胡继君[1] 杨险峰[1] 管一春[1] 孙丽君[1] Yang Liu;Lu Yang;Yunxia Wang;Yiwen Xiong;Bingnan Ren;Jijun Hu;Xianfeng Yang;Yichun Guan;Lijun Sun(Reproductive Center of the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院生殖医学科,郑州450052

出　　处：《中华生殖与避孕杂志》2022年第10期1058-1064,共7页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨不同取精方式对行卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)助孕患者临床妊娠及围产结局的影响。方法采用回顾性队列研究分析2015年10月至2020年10月期间于郑州大学第三附属医院生殖医学科因男性因素行ICSI助孕的患者临床资料,共3096个周期。少弱畸形症患者采用射精方式取精,记为射精组(n=2558);无精子症患者采用手术方法取精(PESA/TESA/mirco-TESE),记为手术取精组(n=538)。比较分析两组患者的促排卵情况、胚胎培养情况,观察两组鲜胚移植患者临床妊娠结局及围产结局指标的变化。结果经过线性/logistic回归调整混杂因素后,手术取精组相对于射精组的优质胚胎数[MD(95%CI)=0.412(0.153~0.670),P=0.002]及囊胚形成数[MD(95%CI)=0.265(0.035~0.494),P=0.024]明显升高,正常受精(双原核)数及可利用胚胎数差异均无统计学意义(均P>0.05);鲜胚移植后患者的胚胎种植率[aOR(95%CI)=1.311(1.010~1.701),P=0.042]及临床妊娠率[aOR(95%CI)=1.307(1.007~1.697),P=0.044]明显升高;组间活产率、多胎率、流产率、单胎早产率、单胎足月新生儿体质量及性别比差异均无统计学意义(均P>0.05)。结论无精子症患者通过手术取精可获得与常规ICSI相当的活产率,并不会增加流产、胎儿畸形、单胎早产、足月低体质量儿等风险。Objective To investigate the effects of different sperm retrieval methods on clinical pregnancy and perinatal outcomes in patients undergoing intracytoplasmic sperm injection(ICSI)for pregnancy.Methods A retrospective cohort study was conducted to analyze the clinical data of patients who underwent ICSI for male factors in Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from October 2015 to October 2020.A total of 3096 cycles were included.Patients with oligozoospermia had sperm retrieval by ejaculation,which was recorded as ejaculation group(n=2558);patients with azoospermia had sperm retrieval by surgical method(PESA/TESA/mirco-TESE),which was recorded as surgical sperm retrieval group(n=538).The ovulation promotion and embryo culture of the two groups were compared and analyzed,and the clinical pregnancy outcome and perinatal outcome indexes of fresh embryo transfer patients in the two groups were observed.Results Data from both groups were adjusted for confounding factors by linear/logistic regression,which revealed that the number of high-quality embryos[MD(95%CI)=0.412(0.153-0.670),P=0.002]and blastocyst formation[MD(95%CI)=0.265(0.035-0.494),P=0.024]were significantly higher in surgical sperm retrieval group relative to ejaculation group,and the number of two pronuclei(2PN)and the number of available embryos were not statistically different(all P>0.05).The embryo implantation rate[aOR(95%CI)=1.311(1.010-1.701),P=0.042]and the clinical pregnancy rate[aOR(95%CI)=1.307(1.007-1.697),P=0.044]were significantly higher in patients after fresh embryo transfer.The differences in live birth rate,multiple birth rate,miscarriage rate,singleton preterm birth rate,singleton full-term neonatal weight and sex ratio between the two groups were not statistically significant(all P>0.05).Conclusion Patients with azoospermia can still obtain a live birth rate comparable to that of conventional ICSI through surgical sperm retrieval and do not increase the risk of miscarriage,fetal malformation,singl

关 键 词：精子注射 细胞质内 取精方式 妊娠结局 围产期结局 

分 类 号：R714.8[医药卫生—妇产科学]